POM Wonderful is a Los Angeles based pomegranate juice company, that has funded considerable research, but got in trouble with the FTC for some ads they ran. They were subsequently skewered in the popular press as well. They paid their fine, removed all research from their web site. Five years later, all is largely forgotten, except that the results launched no end of research into the wonders of pomegranate.

POM Wonderful comes in a bottle that looks like a purple snowman. It is hard to miss. It is distributed fresh. If not kept chilled, it will go bad. At some point in the early 2000’s POM decided to spend a substantial amount (for a juice company anyway) on research, and funded various projects.

One of the first was with the UCLA school of medicine. The research looked at PSA doubling time for people with recurrent prostate cancer. Prostate cancer is often described as the tortoise of cancers as it can take decades to develop. Typically PSA, a blood test marker, more or less tracks the cancer’s progress. The UCLA researchers treated the study as a Phase 2 clinical trial, as though the juice were a new drug.

For those of you not familiar with drug trials, Phase 1 determines the right dose. Phase 2 administers the drug to a cohort to determine if it is safe and if it works. Phase 3 trials are the large expensive ones, which, if successful lead to general availability of the drug.

The ‘dose’ used was 8 oz. of pomegranate juice. The results were nothing short of spectacular. The men’s PSA doubling time slowed drastically, from 15 months to over 54. The results attracted a lot of attention, including that of the POM Wonderful marketing department, who then released a series of, frankly, rather cheesy ads trumpeting these results.

This caught the attention of the FTC, who accused POM of marketing the juice as a drug, fined them, and ordered them to pull all the research results off their web site and kill the ads. (See comments about the FDA in “Is American Health Care Really That Bad” here FTC? FDA? The same problem applies.) The popular press then jumped in and tore to shreds what the FTC had left.

So who won and who lost here? POM is still around, and is actually still funding research, though you find no mention of this on their web site. It seems a bit surreal. What POM apparently did wrong was to promote their juice as something that can fight prostate cancer. There was even decent research backing this up. The moral seems to be that unless you are a drug company, you cannot suggest medical uses for anything you make, no matter how well it works.

But what about the research? The FTC didn’t demolish that, nor has anyone else. In fact, quite a lot of research has continued. Research on POMx, an unsavory sugarless pomegranate goo, was also tested. Here the results were good though far less spectacular. PSA doubling time extended from 11 months to 18 month. Impressive, but not nearly as impressive as the earlier test. Why would this be? Most likely it is has to do with the processing (n.b.!) involved in making the goo. The sugar was removed, but some of the beneficial ingredients seem to have been lost as well.

The lesson here is eat or drink the real thing, not the manufactured supplement. Yet they both seem to work, albeit in varying degrees, so why might this be?

There has been considerable research now on the effects of pomegranate. Much of it has been in vitro (in a test tube or petri dish) or in mice. All sorts of effects are observed, with none of them outstanding. Perhaps the most prominent is a down regulating of VEG-F, a signaling protein that calls for new blood vessels to be built. Building new blood vessels is the last thing we want a tumor to be doing, as they can grow no larger than a grain of rice otherwise.

POM Wonderful is still fighting as well, appealing the earlier decision, but appears to have lost the appeal.

This leaves a sort of gaping hole. Phase 3 clinical trials are incredibly costly, $100 million or more. Only deep pocketed drug companies can afford them, and only then if the expected return is 8 figures or more. This isn’t likely to happen for a fruit juice. Perhaps eventually there will be enough dietary data to make some strong epidemiologically claims, or perhaps not.

So we don’t really know if pomegranate juice slows prostate cancer. It looks promising, but that’s about as far as we can go.

In a related development, an interesting test was done by an English group using a supplement called POMI-T, containing pomegranate, green tea, broccoli, and turmeric, all powered and place in a capsule. POMI-T did NOT fund the study. This pill was tested on men who had prostate cancer and were doing what is called ‘watchful waiting’ meaning keeping it on a short leash, frequent blood draws, etc. This was a placebo vs. real thing sort of test.

Again stunning results. The cancer in the placebo group advanced at four time the rate of the POMI-T group. The cancer in the POMI-T hardly advanced at all.

The POMI-T people seem to have learned from POM Wonderful’s trials and tribulations, discretely referring interested readers to the medical journals: “Gee whiz, no big deal, just a 4-fold reduction in prostate cancer rate. Here’s a link to the journal paper.”

Perhaps evidence based medicine has gone a bit too far. How about common sense based medicine for a change? And also, again n.b., inhibiting VEG-F sounds great if you have prostate cancer, maybe other cancers as well, but this does not mean any and all want to inhibit VEG-F as it is necessary to all repair and replacement processes in the human body. Better to live in such a way as not to get prostate cancer and not to need the cure that might be worse than the bite if taken before disease rather than after. In other words you need to Quantify before even taking a cure for a disease you may not have. Sure, eat some pomegranates, even some juice, but all in balance; a balance ensured by Quantitative Medicine. Bon Appetit.